Fortunately, the General Pharmaceutical Council, in this case, upheld its guidelines and the consequent media coverage has now died down, temporarily at least.

This may seem like a one-off minor incident, but it is an illustration of increasing pressures on freedom of conscience protections. It is often assumed that the role of the conscience in medicine is relevant only to a few specialised and limited areas such as contraception or abortion, but in fact, the concept of the conscience goes right to the heart of what it means to act in a moral way, to act with integrity.

If we do not stand by those who are under pressure, the problems will only get worse and will spread. A well-known quote, often attibuted to Burke though it may have come originally from J S Mill, warns: ‘He should not be lulled to repose by the delusion that he does no harm who takes no part in public affairs. He should know that bad men need no better opportunity than when good men look on and do nothing.’

The Christian Medical Fellowship (CMF) has therefore written to the General Pharmaceutical Council to ensure they are aware of our concerns and to thank them for holding to their guidance. The text of our letter is as follows, with their response after it:

‘I am writing to you following the recent news coverage of a Lloyds pharmacy worker who, according to news reports, conscientiously objected to selling the morning-after pill and directed a customer to another pharmacy instead. I note that a petition has since been set up to prevent pharmacists from claiming conscientious objection rights.

‘The Christian Medical Fellowship is the UK’s largest faith-based group of health professionals and we contributed with both written and oral evidence to your review of your Guidance on Religion, Personal Values and Beliefs. We publicly welcomed the new Guidance and the statement accompanying it, in which the Chief Executive of the General Pharmaceutical Council highlighted the positive contribution that pharmacists’ faith can make in their provision of care. We also welcomed the clear statement that: “Pharmacy professionals have the right to practise in line with their religion, personal values or beliefs”.

‘We all aspire to person-centred care. In any care scenario, there are (at least) two parties – the carer and the one receiving care – each of whom has rights. The General Pharmaceutical Council guidance helpfully achieves a balance between the patient’s right to service access and the pharmacist’s right to freedom of conscience.

Respect for the sincerely held religious and moral beliefs of employees is essential and we are concerned that some of the demands being made, based on this one recent case, would marginalise the beliefs, values and religion of pharmacists disproportionately and unnecessarily, and trivialise their right to freedom of conscience under the law. Despite widespread coverage of this case, we have yet to see evidence of recurring complaints under the present provisions.

‘While we strongly support the right to freedom of conscience for pharmacists, we do also emphasise the importance of openness and sensitive communication with colleagues and employers; any refusal to supply should be made courteously and sensitively.

‘On behalf of CMF, I want to thank the Council for protecting the right of pharmacists to refuse to engage in certain procedures that violate their most profound moral convictions.

‘I also encourage the Council to continue to make it clear, publicly, that all pharmacy professionals have the right to practise in line with their religion, personal values or beliefs.

Yours faithfully

Dr Mark Pickering Chief Executive, CMF

The General Pharmaceutical Council replied with the following two sentences:

‘Our existing guidance In practice: Guidance on religion, personal values and beliefs (to which you refer) remains in place. We have no current plans to review it. As you are aware, the guidance sits under our standards for pharmacy professionals and relates to standard 1, Pharmacy professionals must provide person-centred care.’

The point here is simple but vital: if we care about liberty and personal integrity, we must make a reasoned defence of it in the public square, from the smallest incident to the biggest.

Charles Collins

LEICESTER, United Kingdom – A Catholic bishop in Scotland is urging the country’s political leadership to affirm freedom of conscience, “and hold in high regard those in public life who remain true to their conscience, even at the expense of personal popularity or political advantage.”

Bishop Hugh Gilbert, the president of the Bishops’ Conference of Scotland, made his comments in a letter to Scotland’s First Minister Nicola Sturgeon. . . [Full text]

Michael Cook

A well-known British cosmetic surgeon says that transgender women (ie, natal males) should be entitled to womb transplants when the technique becomes safe and feasible. Children have already been born after womb transplants from live and deceased donors.

Dr. Christopher Inglefield, founder of the London Transgender Clinic and a specialist in “gender confirmation surgery”, told the Mirror (UK) that it would be possible to perform the procedure on a transgender woman. . . [Full text]

Michael Cook

Dr. Evil, a British body modification artist, has been found guilty of three counts of grievous bodily harm for tongue-splitting and nipple removal despite the fact that his clients consented to the procedures.

The argument put forward in court by Dr Evil, aka Brendan McCarthy, was strongly supported in the community. A petition with 13,400 signatures argued “for the right to express ourselves in whatever modified manner we wish in a safe environment”.

Judge Amjad Nawaz ruled that the kind of radical procedures in which Dr Evil specialised were not analogous to tattoos and piercings. . .[Full text]

Michael Cook

A controversial poll by the Royal College of Physicians, in the UK, is expected to result in a change in its position on “assisted dying”. Polling ends on March 1 and the result will be announced later in the month.

If the email poll fails to reach a supermajority of 60% who oppose a change from the status quo of opposition, the official position of the College will change to neutrality.

On the face of it, the procedure for the poll is bizarre. If 59% of the RCP’s 35,000 members support opposition to “assisted dying”, which in any democratic election would be an overwhelming victory with a margin of 18 percent, they still lose.

In fact, a former chair of the RCP’s ethics committee has threatened legal action. Dr John Saunders described the vote as a “sham poll with a rigged outcome”. In a letter to The Guardian he contended that the RCP would change its position to neutral even if the result were the same as a 2014 poll, when 57.5% of the doctors who voted did not “support a change in the law to permit assisted suicide by the terminally ill”.

Another group of doctors wrote a letter to The Times in which they accused a cabal of hijacking the RCP. “We are worried that this move represents a deliberate attempt by a minority on the RCP council to drop the college’s opposition to assisted suicide even if the majority of the membership vote to maintain it.”

The RCP President, Dr Andrew Goddard, insists that the poll is both fair and necessary. “It is important that the RCP represents fairly the views of its full membership. We will go ahead with the survey as planned.”

He is quite aware of the impact that a change would have upon public opinion. “The RCP is frequently asked for its stance on this high profile issue, which may be cited in legal cases and parliamentary debate, so it is essential that we base this on an up-to-date understanding of our members’ and fellows’ views.”

Although some reports assumed that “assisted dying” means “assisted suicide”, the RCP’s definition seems to encompass euthanasia as well: “The supply by a doctor of a lethal dose of drugs to a patient who is terminally ill, meets certain criteria that will be defined by law, and requests those drugs in order that they might be used by the person concerned to end their life.” In Oregon, where only assisted suicide is legal, “a physician prescribes a lethal dose of medication to a patient, but the patient – not the doctor – administers the medication.”

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David Maddox

MORE than 1,000 doctors have signed a letter opposing alleged attempts by the Royal College of Physicians to become “neutral” on assisted dying.

The college is locked in a row with members over its position.

Although a poll in 2014 found 58 percent did not support it, the college says unless it has a 60 per cent majority for or against, it will adopt a neutral view. It is conducting a new poll but with a three-way question, which opponents say makes the majority harder to obtain. . .[Full text]

Nick Benson

Pro-life groups have claimed that the recent drop in applications to midwifery courses could be rectified by enshrining conscientious objection.

Recent figures show that there has been a 35 per cent drop in the number of applicants to midwifery courses since 2013. The Royal College of Midwives (RCM), which analysed the latest Ucas data for England, said the biggest reduction was in those aged 21 or over.

In 2013, more than 12,000 people aged over 21 applied for a midwifery course in England, but by 2017 that figure had dropped to just 6,700 – a decrease of 45 per cent. . . [Full text]

Over the last decade, the culture wars in the United States have broken new ground: They have become battles over the rights of conscience. For example, now that same-sex marriage is a right, the question before the U.S. Supreme Court in the case of Masterpiece Cakeshop is whether its sympathetic, telegenic owner, Jack Phillips, is within his rights to refuse to make a wedding cake for a gay couple. Similarly, under the Obama administration, the court heard arguments more than once over whether employers who object on religious grounds to contraceptives or abortion should be exempted from having to provide employees health insurance that includes such services.

By contrast, debates over conscientious objection in medicine have not had the same notoriety, though they have broken out repeatedly among health care professionals and medical ethicists since the turn of the century, when there was a flare-up over pharmacists’ refusing to fill prescriptions for emergency contraceptives.

A bill currently before the House of Lords has brought conscientious objection in medicine into widespread public discussion in the United Kingdom, if not yet on the other side of the Atlantic. . . [Full text]